Assessing the impact of medication use on trends in major coronary risk factors in older British men: a cohort study

Abstract

Aims

To investigate the role of medication in 20-year trends in blood pressure (BP) and blood lipids in older British men. Methods and results BP and lipids were measured in 4231 men from a representative cohort at baseline (1978–1980, aged 40–59 years) and after 20 years (1998–2000). Cohort-wide age-adjusted 20-year mean changes were as follows: systolic BP – 7.6mmHg (95% confidence interval: – 9.7 to – 5.4); diastolic BP + 3.3mmHg (+2.2 to + 4.5); nonhigh-density lipoprotein (HDL)-cholesterol – 0.4 mmol/l (– 0.5 to – 0.2); HDL-cholesterol +0.16 mmol/l (+ 0.13 to + 0.19). Much (79%) of the systolic BP fall occurred only among 1561 men (37%) reporting the use of BP-lowering medication during the follow-up; systolic BP changed by – 12.3mmHg (− 14.7 to – 9.9) and – 1.6mmHg (– 3.7 to + 0.5) among medication users and men not using medication, respectively (P <0.001 for medication–time interaction). One-third of the non-HDL-cholesterol fall occurred only among 302 men (8%) reporting the use of lipid-regulating drugs; non- HDL-cholesterol changed by – 1.8 mmol/l (– 2.0 to – 1.6) and – 0.2 mmol/l (– 0.4 to – 0.1) among medication users and men not using medication, respectively (P <0.001 for interaction). The HDL-cholesterol increase was not associated with lipid-regulating drug use (P = 0.15 for interaction).

Conclusion

Decreases in BP were largely confined to medication users and overall changes in non-HDL-cholesterol were modest, suggesting the need for greater efforts to reduce BP and cholesterol among the general population. HDL-cholesterol increased among all men, likely reflecting cohort-wide improvements in associated health behaviours.